Growing integrated healthcare provider seeks a National Medical Director to lead the company’s utilization management clinical team. This is a remote role with associated travel, so candidates can live in any US city with easy access to major airport.

typical roles and responsibilities for National Medical Director – UM

  • Oversee utilization management team activities including reviewing requests and making coverage determinations for services and supplies for delegated lines of business.
  • Act in a leadership role as medical manager and policy advisor to the company and clients.
  • Executes the Utilization/Cost Management Programs and relevant Clinical Quality Improvement Programs in partnership with the company leadership
  • Interfaces with provider community on Utilization Management and evidence-based medicine
  • Provides education to provider teammates in local markets and to the UM team regarding managed care processes as well as clinical issue 

Requirements for National Medical Director – UM Physician

  • M.D. graduate of an accredited medical school, MBA or advanced degree in healthcare management preferred
  • U.S. M.D. licensure, board certified in internal medicine, family medicine or primary care.
  • 5+ years’ experience as a physician reviewer performing peer review activities.
  • 2+ years managing UM team, including regional UM physicians
  • Experience with the dual eligible Medicare / Medicaid population
  • 3+ years post residency experience in clinical practice
  • Progressive medical administration experience strongly preferred
  • Proven ability in a medical leadership position in clinical credibility with experience developing and guiding team members
  • A strong understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
  • Strong interpersonal, verbal, and written communication skills.
  • The ability to navigate in a corporate matrix environment